Schools in Mass. report nearly 3,000 concussions

A partial but worrisome look at head injury crisis

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Boston College High School played against Malden Catholic on Friday. Of 164 schools, BC High reported the highest number of head injuries sustained in extracurricular activities.

By Lisa Kocian
Globe Staff
October 28, 2012

Nearly 3,000 Massachusetts students suffered a concussion or other head injury while playing sports during the last school year, according to the results of a first-of-its-kind survey completed by 164 schools.

The reports from middle and high schools across Massachusetts, collected under a state law passed in 2010, highlight the extent of the problem at a time when medical experts and sports leagues, from Pop Warner to the NFL, are increasingly worried about the long-term effects of head injuries.

Boston College High School, an all-boys private school in Dorchester with grades 7 through 12, reported the highest number, with 76 head injuries sustained last school year during “extracurricular athletic activities,’’ according to reports released to the Globe by the state Department of Public Health under a public records request. Lexington High School followed with 69 reported head injuries or concussions.

“I think kids now are more aware and recognize the dangers of head trauma,” said Jon Bartlett, athletic director at BC High, which has about 750 students playing 17 sports. “You’re seeing bigger, faster, stronger kids these days, so the collisions are a little more violent than years ago.”

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But the reports also show a wide variance in the number of head injuries reported at Massachusetts schools, either as a result of differing reporting standards at schools or confusion over the new law. About 525 schools, including some private institutions, missed the August reporting deadline. There is no penalty for not reporting on time.

Twenty-nine schools reported head injuries in the single digits, a sharp contrast to the dozens reported by other schools. While several of the schools with relatively few head injuries are charter schools or private schools with limited sports offerings, low numbers were also reported by large sports programs.

Medford High School, New Bedford High School, and Newton North High School
have significant athletic offerings and each reported 11 head injuries across all sports for the entire school year.

“Maybe our numbers are low and next year they could be extremely high,” said Tom Giusti, athletic director at Newton North. “We take this very seriously, and we’ve provided all the education, in terms of knowing concussion signs and symptoms. We’ve been proactive about keeping kids out and having kids follow through with doctors.”

Marie DeSisto, director of nurses for the Waltham public schools, submitted the high school’s data to the state. She wrote down “92 known concussions,” but when contacted by the Globe said that was every concussion she knew about, both in and out of school. The number she had for sports alone was 54, which she didn’t put on the form.

“There’s still some confusion about what things mean,” said DeSisto, who is also Massachusetts director for the National Association of School Nurses.

Several perennial football powerhouses aren’t among those whose forms were released by the state, including Everett High School, Marshfield, and Xaverian,. This was the result, in some cases, to misunderstandings over the new requirement.

Everett’s athletic director insists he submitted a form, though it wasn’t included in the group released by the state. And Marshfield athletic director Lou Silva said he didn’t know why the state didn’t have his school’s form, since he expected another school staff member to submit the data. The Xaverian head coach said his staff filled out the form, but wasn’t aware it needed to be submitted to the state.

At the request of the Globe, Dr. Michael O’Brien, associate director for the Sports Concussion Clinic at Boston Children’s Hospital, reviewed the data received so far. He said the huge range in the numbers tells him there is probably underreporting by some students.

Several studies document that athletes are underreporting concussions, he said, by “either not recognizing it or, more often, not getting the message that concussion is a serious long-term injury.”

Dr. Lauren Smith, medical director for the state Department of Public Health, which is responsible for collecting the head injury data from schools, agreed that students have been hesitant to admit to head injuries, but she thinks that is changing because of better education.

“We’re in a transition period, where public awareness is increasing,” said Smith. “I expect an increase in concussion reporting.”

The purpose of the new law is to protect students’ health and safety by providing consistent standards across the state for the prevention of head injuries, training on the topic, and clear rules governing when players are allowed to return to the field.

The law covers a wide range of sports extracurriculars including cheerleading, ultimate Frisbee, and marching band. It applies to public middle and high schools, and any school subject to Massachusetts Interscholastic Athletic Association rules. Schools are not asked to break down the numbers by individual sports.

In addition to the state’s new reporting mandate, the law also requires schools to provide annual training to students, parents, and staff on how to recognize and respond to head injuries. Injured students must get medical clearance before returning to play, and then must do so gradually. Parents are supposed to notify the school of any head injuries that students get outside of school, and those numbers are also reported to the state.

Reports of sports-related injuries are on the rise among young people nationwide, as medical professionals increasingly warn that repeated concussions can cause lifelong problems if they are ignored, potentially affecting memory, language, and emotions.

“Your brain is who you are and how you interact with the world,” said Dr. Julie Gilchrist, a pediatrician and researcher for the Centers for Disease Control and Prevention. “The issue is if it’s not recognized, potentially their recovery can be hampered to the point that they might not fully recover.”

Earlier this year, the Globe did its own surveys of local high school sports, including football, soccer, ice hockey, and basketball. Those surveys found higher numbers of head injuries in football and girls’ soccer, a trend that meshed with national statistics.

Smith cautioned against comparing schools and said the data released by the state has not yet been checked for accuracy.

“It’s not meant for direct comparison among schools, and the reason for that, as you could probably imagine, is that schools have different-sized student populations and they have different numbers of students participating in school sports activities,” she said.

For example, at least 317 Massachusetts high schools are using ImPACT,a computerized cognitive test that students take before they play so they have a baseline for comparison after a head injury. There is also increased interest in the newest equipment, such as improved football helmets. And Pop Warner declared in June that it would limit contact in football practices, a step that several local high schools, like Newton North high, have also made.

Charlie Stevenson, head coach of the Xaverian football team, said that the increased attention to concussions has affected his coaching. “There is some hitting in practice, but I say we spend more days only doing uppers [upper body workouts] rather than full contact, more emphasis on keeping your head out of the game,’’ he said in an interview. “I feel we’ve always done that and it’s just more an intense focus now.”

O’Brien, the Children’s Hospital physician, is working with a group of doctors who this month broke ground in Waltham on the Micheli Center for Sports Injury Prevention, which will offer concussion prevention strategies.

They will study whether strengthening neck muscles, for example, could help cut down on concussions, said O’Brien. And researchers will examine if there are certain risk factors that make athletes more vulnerable to concussion.

DeSisto, the Waltham nurse, said the data collected under the state law could be a great resource to help figure out why concussions happen and how to prevent them. She is working on that as part of a grant from the Department of Public Health. Waltham is one of 80 districts bringing together school officials to talk about a wide range of health issues, including concussions, she said.

Waltham is trying to go above and beyond the law by collecting head injury numbers on all students in prekindergarten through 12th grade, regardless of where the injury took place. And even at the elementary level, school nurses are trying to educate all staff and parents on the importance of recognizing concussion symptoms, she said.

One of the biggest hurdles for recovery at any age is the need for cognitive rest, said the CDC’s Gilchrist.

Parents generally understand their child can’t play sports for awhile after a concussion, but there is still a need to educate teachers and parents about the importance of limiting academics, screen time, and other mental activities that can stress an injured brain.

Still, she warned against overreacting.

“I know parents are worried, but the benefits of physical activity are critically important,” said Gilchrist. “We need kids out there being kids. We just need parents to help them do it safely.”

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